Lessons Learned from the Testing of Neonatal Vitamin A Supplementation

Nutrients
Christine S BennAne B Fisker

Abstract

A total of 12 trials have tested the effect of neonatal vitamin A supplementation (NVAS) on mortality. Overall, NVAS had no effect on mortality, but results were heterogeneous. Two competing hypotheses have been put forward to explain the divergent effects: A) NVAS works by preventing vitamin A deficiency (VAD) and not all countries have VAD; B) NVAS interacts negatively with subsequent diphtheria-tetanus-pertussis (DTP) vaccine, increasing mortality in females; in countries with low DTP coverage NVAS may have a beneficial effect. Only hypothesis A was tested in a recent meta-analysis; there is no strong empirical support for hypothesis A and it would not explain observed negative effects in some settings. Hypothesis B accounts for most observations. However, so far it has only been tested properly in a few trials. If hypothesis B is correct, it has major consequences for the understanding of the effects of vitamin A, and for the VAS policy in older children. As a WHO priority, the DTP coverage is bound to increase, and therefore hypothesis B urgently needs to be tested.

References

Sep 1, 1985·Pediatric Research·J P ShenaiM T Stahlman
Jul 1, 1995·The American Journal of Clinical Nutrition·K P WestA Sommer
Apr 1, 1996·The Journal of Pediatrics·J H HumphreyA Sommer
Oct 16, 2003·International Journal of Epidemiology·Christine Stabell BennPeter Aaby
Feb 9, 2005·The American Journal of Clinical Nutrition·Lucie C MalabaUNKNOWN ZVITAMBO Study Group
Jul 16, 2005·Clinical Microbiology Reviews·Eduardo Villamor, Wafaie W Fawzi
Sep 28, 2005·Tropical Medicine & International Health : TM & IH·Lawrence H MoultonJames M Tielsch
Jan 9, 2007·Tropical Medicine & International Health : TM & IH·Henrik JensenPeter Aaby
Oct 9, 2007·The American Journal of Clinical Nutrition·Ane B FiskerChristine S Benn
Jun 19, 2008·BMJ : British Medical Journal·James M Tielsch
Sep 18, 2008·International Journal of Epidemiology·Christine Stabell BennPeter Aaby
Jul 31, 2009·The American Journal of Clinical Nutrition·Christine S BennDavid A Ross
Nov 26, 2010·Scandinavian Journal of Infectious Diseases·Mathias Jul JørgensenChristine Stabell Benn
Aug 20, 2014·Pediatrics·Ane B FiskerChristine S Benn
Oct 13, 2014·International Journal of Epidemiology·John MasonJoshua Yukich
Jul 22, 2015·Lancet·Christine Stabell BennAne Bærent Fisker
Aug 12, 2016·The Journal of Nutrition·Sherry A TanumihardjoDaniel J Raiten
Mar 3, 2018·BMJ : British Medical Journal·J B MasonAlfred Sommer
Nov 15, 2018·Archives of Disease in Childhood·UNKNOWN Neonatal Vitamin A Supplementation Evidence group

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Citations

Mar 3, 2020·Frontiers in Pediatrics·Christine S BennPeter Aaby
Nov 21, 2020·Advances in Nutrition·Bryan M GannonSherry A Tanumihardjo

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Software Mentioned

NVAS

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